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Failure to limit dietary sodium leads to thirst, large fluid weight gain, and poor outcomes in patients receiving hemodialysis. Perceived benefits and barriers may influence adherence; however, tools measuring these relationships are not available. This study's purpose, based on the health belief model, was to evaluate the reliability and validity of the Beliefs about Dietary Compliance Scale (BDCS), describe perceived benefits and barriers over time, and identify individual benefits and barriers that may be amenable to tailored interventions. A convenience sample of 229 completed the BDCS at baseline. One week after baseline, 52 participants completed the BDCS to assess test-retest reliability. Four months after baseline, 187 participants (81%) remained. Cronbach's alphas for the scale ranged from .66 to .81. One-week test-retest reliabilities ranged from .68 to .86. Factor structure was supported by factor analysis. Scores remained stable over time. Barriers to dietary sodium limitations were common and more in need of intervention.

Heart failure is nearing epidemic proportions and there is a need for innovative approaches to care that facilitate learning and behavioral change in order to improve health outcomes. This article discusses the development and pilot testing of the PUMP UP program, a tailored computerized intervention, designed to improve 4 health outcomes. The development phases included evaluation of knowledge and design and computerization of the intervention. Pilot testing was completed with 12 patients recruited from primary medicine clinics. Patients completed a baseline telephone interview; follow-up data were obtained immediately after the intervention clinic visit and at 4, 8, and 26 weeks after the visit. Four of the 12 patients met the outcome of improved provider adherence to guidelines. Health-related quality of life scores improved at 26 weeks after baseline. The PUMP UP program was informative and feasible to deliver. It is now ready for testing in intervention studies with larger samples.

Preamble......237 Medicine is experiencing an unprecedented focus on quantifying and improving health care quality. The American College of Cardiology (ACC) and the American Heart Association (AHA) have developed a multi-faceted strategy to facilitate the process of improving clinical care. The

Background and research objectives Patients with heart failure (HF) may be predisposed to malnutrition. Little is known about the nutritional status of patients with HF, particularly patients who have coexisting major medical conditions such as chronic kidney disease. The purposes of this study were to (1) describe the nutritional status of 211 patients with chronic HF, (2) examine relationships between nutrition variables and health-related quality of life, and (3) evaluate the nutritional status of the subset of HF patients with coexisting chronic kidney disease. Subjects and methods The sample included 211 patients with chronic HF recruited for a larger study about health-related quality of life. Clinical data were retrieved retrospectively from the computerized medical records system at the study site. Results and conclusions Mean body mass index of the 122 patients for which height was available was 31.4, and no differences in body mass index were noted among patients with varying New York Heart Association class functional status. Evaluation of the mean laboratory values indicated that patients had abnormal elevations of serum glucose, hemoglobin A1C, creatinine, and low-density lipoprotein cholesterol. Higher hemoglobin A1C levels were significantly correlated with poorer health-related quality-of-life scores, although the magnitude of the correlations was modest. Estimated glomerular filtration rate indicated that 54 (27%) of the HF patients likely had coexisting chronic kidney disease, and these patients had significantly lower serum albumin and worsening anemia. The results indicate the need for future prospective studies that incorporate evaluation of nutritional status and the ways in which coexisting chronic kidney disease influences outcomes.

Purpose:To describe a conceptual model to guide studies of cognitive deficits among patients with heart failure. Organizing Framework:The conceptual framework of cognitive deficits in chronic heart failure is based on theoretical and empirical literature about (a) the pathophysiology of heart failure, (b) the pathophysiology of cognitive deficits, and (c) health-related quality of life. Other variables that may cause or contribute to cognitive deficits include age, the relative contributions of multiple comorbid conditions, hypertension, and depressive symptoms. Covariates that might influence cognitive deficits (medications, gender, and education) are also included in the model. The most prominent cognitive deficits are believed to occur in domains of attention, working memory, memory, learning, executive function, and psychomotor speed. The main outcome variable is health-related quality of life, which is believed to be influenced by circulatory insufficiency and cognitive deficits. Conclusions:The conceptual model described in this paper is a framework for testing cognitive deficits that occur in heart failure. After validation through empirical testing, the model may be useful in developing interventions for patients with heart failure whose care is complicated by cognitive deficits.

Background: Although numerous health-related quality-of-life instruments are available to measure patients' quality of life. few studies have compared these measures directly to determine how they function in the same group of patients ? Objective: The purpose of this study was to empirically compare psychometric properties of the Chronic Heart Failure Questionnaire (CHQ), the Minnesota Living with Heart Failure Questionnaire (LHFQ), and the General Health Survey Short-form-12 (SF-12). ? Sample: A convenience sample of 211 patients with heart failure completed baseline questionnaires; 165 patients completed the entire 26-week study. ? Methods: Patients completed telephone interviews at baseline and at 4 8 and 26 weeks after baseline. To compare mode of administration, a subset of patients (n = 173) completed face-to-face and telephone interviews ? Results: Patients reported low-to-moderate health-related quality-of-life overail. Reliability of the three instruments was satisfactory. Responsiveness to changing condition, as evaluated by analysis of variance, receiver operating curve characteristics, and the minimal clinically important difference method, indicated that the CHQ and LHFQ were more responsive to changing conditions than the SF-12. No major differences were noted betweer the scores of the face-to-face interviews and the baseline telephone interviews. The LHFQ and SF-12 were easier ann took less time to administer than the CHQ. ? Conclusions: While all three instruments were reliable and valid, the CHQ and LHFQ were more sensitive than the SF 12 in detecting clinically important changes over time.

Health-related quality of life (HRQL) instruments have been used to measure HRQL in heart failure patients, but how different instruments compare in the same groups of patients is not known. The purpose of this study was to compare the reliability and validity of three HRQL measures in 211 heart failure patients recruited from clinics affiliated with an urban hospital. Two disease-specific instruments, the chronic heart failure questionnaire (CHQ) and the living with heart failure questionnaire (LHFQ), and one generic instrument, the short-form 12 (SF-12), were administered. Patients reported moderate to low HRQL scores. Floor or ceiling effects were noted in the disease-specific instruments. Internal consistency reliabilities of the CHQ and LHFQ were satisfactory. Construct, convergent, and discriminant validity were supported for each instrument. Each scale and subscale, except for the SF-12 mental component scale, differentiated between patients with New York Heart Association (NYHA) class I, II, and III plus IV; the LHFQ physical subscale was the only measure to differentiate between patients with NYHA class III and IV. All three instruments were satisfactory for measuring HRQL, but the disease-specific instruments were preferable to the generic instrument. The decision of which instrument to use depends on the purpose of the study.

Background: Lack of medication and dietary compliance leads to troublesome symptoms and hospitalization in patients with heart failure. Compliance behaviors are influenced by beliefs about the behavior. Objective: The purpose of this study was to evaluate the reliability and validity of the Beliefs about Medication Compliance Scale (BMCS) and the Beliefs about Dietary Compliance Scale (BDCS) among patients with heart failure. Theoretical Framework: This study’s theoretical framework is the Health Belief Model. Methods: A convenience sample of 234 patients with heart failure completed the BMCS and the BDCS. Patients completed the scales at baseline by face-to-face interviews and at 8 and 52 weeks after baseline by telephone interview. Results: Construct validity of the scales was supported by confirmatory factor analysis. Both the BMCS and the BDCS had benefits and barriers scales with clear factor loadings. The internal consistency reliability estimates of the scales ranged from.63 to.88, with the BMCS having some estimates lower than.70. The test-retest reliability estimates ranged from.07 to.57. The intraclass correlation coefficient estimates were higher between the 8-week and 52-week scores for all scales. Possible reasons for the varying estimates are discussed. Conclusions: The BMCS and the BDCS have documented reliability and validity. Future work should be directed at evaluating the responsiveness of the scales to changing patient conditions and testing interventions to improve medication and dietary compliance through changing beliefs. (Heart Lung ® 2001;30:177-85.)

Objectives: Objectives of this study were to: (1) describe perceived social support during a baseline hospitalization and 12 months later among heart failure patients; (2) examine differences in social support as a function of gender and age (less than 65 and 65 years or older); and (3) examine social support as a predictor of health-related quality of life. Background: Social support is a predictor of well-being and mortality, but little is known about support patterns among heart failure patients and how they influence quality of life. Methods: The sample included 227 hospitalized patients with heart failure who completed the Social Support Survey and the Chronic Heart Failure Questionnaire at baseline; 147 patients completed these questionnaires again 12 months after baseline. Results: Mean baseline and 12-month total support scores were 56 and 53, respectively, with a score of 76 indicating the most positive perceptions of support. The ANOVA indicated significant interactions of gender by age for total (F = 5.04; p = 0.03) and emotional/informational support (F = 4.87; p = 0.03) and for positive social interactions (F = 4.43; p = 0.04), with men under age 65 perceiving less support than men aged 65 and older and women in either age group. Baseline support did not predict 12-month health-related quality of life, but changes in social support significantly predicted changes in health-related quality of life (R2 = 0.14). Conclusions: Overall, perceptions of support were moderate to high, but there was wide variation in perceptions over time. Men under age 65 reported less support than other groups of patients. Importantly, changes in social support were significant predictors of changes in health-related quality of life.

Background The troublesome symptoms experienced by patients with chronic heart failure are associated with diminished quality of life, frequent hospitalizations, and mortality. Objectives To describe the symptoms experienced by patients with heart failure, to detail the self-care strategies used by these patients in managing their symptoms, and to categorize the self-care strategies. Methods Six focus groups were used with 23 patients who had heart failure, along with six focus groups with 18 family members of the patients. Data analysis was performed by transcription of audiotape recordings of the group sessions and review of field notes. Results The patients reported a large number of troublesome symptoms, many consistent with past empirical findings, but some not reported in previous studies. Self-care strategies to manage the symptoms clustered into 11 categories. Conclusions Results from this study provided direction for future studies to (a) identify the prevalence, severity, and etiologies of the commonly reported symptoms, particularly cognitive impairment, loss of balance, and depression; (b) evaluate the emotions reported by women with heart failure; and (c) test the strategies as part of an intervention program to improve symptom management in patients with heart failure.

(1) Exercise intolerance, as a hallmark symptom in patients with heart failure, has been the focus of numerous research initiatives in recent years. The purpose of this review is to synthesize the current literature in order to provide the clinician with an understanding of the state of knowledge regarding the role of exercise in treatment of heart failure. Many studies speak to the effect of exercise training in this population. While sample sizes have been small and restricted predominantly to male subjects with ischemic cardiomyopathies, strong support has been documented in favor of beneficial effects of exercise in heart failure. Future research should target more representative subject pools (i.e., females, non-ischemic cardiomyopathies, cultural minorities, frail elderly, and NYHA class IV), evaluation of impact on quality of life outcomes, exploration of different types and intensity of exercise, and formulation of specific activity prescription tools which can guide practitioners in making activity and/or exercise recommendations to those patients who have no access, or limited access, to cardiac rehabilitation programs.

BACKGROUND: The model for management of patients with heart failure may be a key determinant of morbidity and quality of life. Development of a better management strategy for these patients requires determination of the reasons for decompensation that leads to hospitalization. OBJECTIVES: To ascertain and rank the principal reasons for hospitalization of patients who have heart failure. METHODS: Retrospective audit of all 1992 admissions (N = 1031; 691 patients) coded for heart failure at a Veterans Affairs medical center and a tertiary care university medical center. RESULTS: The diagnosis of heart failure was verified by preset criteria in 72% of the patients. Of the 496 patients with documented heart failure, worsening heart failure was a main reason for admission in 390 (79%). Despite different socioeconomic backgrounds, excessive sodium retention was the leading factor (55%) associated with decompensation in patients at both institutions. Other factors precipitated admission much less often. CONCLUSIONS: Many hospitalizations for heart failure might be avoided by case management directed at lessening sodium overload. Increased use of medications known to be effective in persons with heart failure (angiotensin-converting enzyme inhibitors, digoxin, and adequate diuretic therapy) might reduce the likelihood of decompensation. Implementation of behavioral interventions to assist patients with self-monitoring signs of sodium retention and to improve compliance with medications and dietary sodium restrictions are strategies for further reducing the risk of decompensation.

BACKGROUND: Sodium retention is often a precursor to hospitalization in people with heart failure (HF). Lack of compliance with medications and with dietary sodium restrictions affects sodium retention. OBJECTIVES: The purpose of this study was to evaluate the reliability and validity of the Beliefs about Medication Compliance Scale and the Beliefs about Dietary Compliance Scale. METHODS: The Beliefs about Medication Compliance Scale and the Beliefs about Dietary Compliance Scale are instruments we developed specifically to measure beliefs about compliance with behaviors that affect sodium retention in persons with HF. The scales, based on the Health Belief Model, were designed from a review of literature and from self-reports of people with HF. A convenience sample of 101 people with HF completed the scales. RESULTS: Internal consistency reliability was satisfactory. Factor analysis provided initial support for construct validity of the scales. CONCLUSIONS: Future testing of the scales is needed in more diverse populations. The scales can then be used to test interventions tailored to individual subjects' beliefs about compliance. (Heart Lung ® 1997;26:273-9)

The purpose of this study was to evaluate the reliability and validity of the Cardiac Event Threat Questionnaire (CTQ). The CTQ is a 31-item instrument specific for cardiac events that was developed from a literature review and self-reports of persons who had experienced a recent cardiac event. A convenience sample (N = 270) of persons hospitalized for angina, myocardial infarction, or cardiac surgery completed the CTQ. Satisfactory internal consistency and test-retest reliabilities were found. Results of confirmatory factor analysis and correlation with the Profile of Mood States provide initial support for construct validity of the CTQ.

Selected theoretical relationships from Lazarus' (1966) model of stress were tested in a convenience sample of 81 postmyocardial infarction clients. Two hypothesized causal models were analyzed. Results from regression analyses indicated 63% of the variance in coping effectiveness was explained by marital status, length of time since hospitalization, perceived availability of social support, uncertainty, degree of threat, coping strategies, and emotions. A revised model that fit the data was proposed. Findings indicated that emotions were an outcome of threat, not coping; threat did not directly affect coping strategies; and coping strategies did not directly influence coping effectiveness. © 1993 John Wiley & Sons, Inc.

Abundances of heterotrophic (HF), autotrophic (AF), and mixotrophic (MF) nanoflagellates in Lake Oglethorpe, Georgia, were in the range 102–104 cells ml−1. Pigmented and nonpigmented flagellate abundances were positively correlated with each other in samples spanning a year, but were not significantly correlated to the same physical parameters (temperature, oxygen, light). The highest density of nonpigmented flagellates (> 1 × 104 ml−1) was found in spring 1986 at the surface, although most abundance peaks ranged from 4 to 7 × 103 cells ml−1 and occurred in the metalimnion during summer stratification. Abundances of pigmented flagellates (AF + MF) were greatest (9 × 103 cells ml−1) in surface waters in early spring and late fall when the lake was not stratified. Up to 38% (avg 10%) of all pigmented flagellates at any depth also ingested particles, while the percentage of HF that were identified as bacterivores ranged from 30 to 100%. In situ grazing rate measurements indicated strong seasonal differences in the relative grazing impact of pigmented and nonpigmented flagellates, with HF dominating grazing on picoplankton except in winter.

A changing health care system makes this an opportune time for nursing faculty to use their expertise to improve the public's health care. The author explores the benefits to the individual, the profession, the university, and the health care system of merging the entrepreneurial philosophy and role with the traditional nurse faculty role.

Patients with heart failure are required to comply with a medication regimen and dietary sodium restrictions. The objectives of this study were to determine the most frequently perceived benefits of and barriers to compliance with medication and dietary sodium restrictions and evaluate the relevancy of these scale items for testing in tailored intervention studies. Data were collected as part of two studies that evaluated the psychometric properties of two questionnaires. The most frequently identified benefit of medication compliance was decreasing the chance of being hospitalized, and the most commonly reported barrier was disruption of sleep. Patients were knowledgeable about the benefits of compliance with dietary sodium restrictions, and the poor taste of food on the low sodium diet was the most common barrier. Heart failure patients perceive benefits of and barriers to compliance with therapeutic regimens that are likely to be amenable to tailored interventions designed to enhance compliance.

Table of Contents 1. Uses for HF Data Standards 1892 2. Balance Between Focus and Comprehensiveness 1893 3. Balance Between “Primary” and “Summary” Data Elements 1893 4. Variety of Disease States Leading to HF 1893 5. Acute and Chronic Care, Inpatient and Outpatient Care Venues 1893 6. Therapy for HF 1893 7. Outcomes Assessment for HF 1893 1. III. HF Clinical Data Standards Elements and Definitions 1893 The American College of Cardiology (ACC) and the American Heart Association (AHA) recognize …

Although health-related quality of life is diminished among patients with chronic heart failure, few investigators have examined interactions of age and sex with health-related quality of life longitudinally.To examine differences in health-related quality of life among 4 groups of patients with heart failure on the basis of age (65 years andor = 65 years) and sex and to evaluate relationships of age and sex to changes in health-related quality of life during 6 months.Patients from 2 outpatient clinics in an urban county hospital were interviewed at baseline and 26 weeks later Health-related quality of life was measured by using the Minnesota Living With Heart Failure Questionnaire and the Chronic Heart Failure Questionnaire.A total of 165 patients (52% women; mean age, 57.6 years) completed interviews at baseline and 26 weeks later. At baseline, patients younger than 65 years had poorer health-related quality of life scores on total scales and some subscales than did older patients. Women had poorer scores than did men on some scales, particularly the emotional subscales. At 26 weeks, patients younger than 65 had poorer total health-related quality of life on 1 scale than did patients 65 and older, and women had poorer scores than did men on 1 total scale. With demographic and clinical factors controlled for, women younger than 65 had improvements in health-related quality of life on some scales.Women younger than 65 years had relatively poorer initial health-related quality of life that improved after 26 weeks.

Seeking-out behavior, defined as a collective group of behaviors practiced by the nursing student when planning and implementing care for clients, is proposed as the successful criterion for clinical learning experiences. The author describes relevant attributes and implications of seeking-out behavior. A model of clinical teaching is proposed in which seeking-out behavior is a key concept. The model is evaluated using Fawcett's criteria of pragmatic adequacy.

Persons with heart failure (HF) experience impaired quality of life (QOL). However, the majority of research conducted on QOL in persons with HF has been with men. The purpose of this descriptive pilot study was to describe the impact of symptoms of HF and examine the relationships among symptom impact, perceived health status, perceived social support, and overall QOL in 30 women who had recently been hospitalized for HF. The women reported high physical symptom impact, poor perceived physical health status, and impaired QOL. Physical symptom impact, perceived physical health status, and QOL were moderately to highly correlated with one another. Perceived social support was significantly, though not strongly, correlated with physical symptom impact. Emotional symptom impact and mental health status were significantly and negatively correlated with each other but were not significantly correlated with QOL. In this group of 30 chronically ill women, QOL was lower in those women who reported greater physical symptom impact and poorer perceptions of their physical health status.

The potential importance of interactive multimedia in the tertiary environment and in physics education is well recognised world wide, with development projects being funded by universities and government bodies. To date, however, there have been few opportunities to critically assess the importance, acceptability and suitability of these new techniques to physics education. Our study evaluated an interactive tutorial, developed at the Australian National University, covering the photoelectric effect and related material targeted at first and second year students. Pre- and post-test questionnaires using scaled and open answers, observations by teaching staff and informal discussions, were conducted with 35 students in the Department of Physics and Theoretical Physics. Results from an independent survey of the course were also obtained. Our principal conclusion is that while interactive multimedia shows a high degree of acceptability with our study group, any practical application must have a meaningful assessable component and be fully integrated into the lecture series, as opposed to being offered as a study resource alone.

Osteoporosis is a serious health hazard mainly affecting postmenopausal and elderly women. An estimated 200 million people worldwide have the disorder (Christiansen, 1990). Osteoporosis predisposes its victims to fractures of the spine, wrist, and hip with minimal or no trauma. In the United States each year, 250,000 people, 90% of whom are women over 70 years of age, suffer osteoporotic hip fractures (Bauer, 1991). Osteoporotic fractures are one of the leading causes of morbidity and death in the elderly population. About 20% of the individuals die from complications and 50% are permanently disabled (Christiansen, 1990).

Bacterivory in eutrophic Lake Oglethorpe, Georgia, was determined by direct observation of tracer particle uptake by all members of the planktonic community. Heterotrophic flagellates dominated grazing at all times, accounting for 49-8 1% of grazing on an areal basis and up to 98% of grazing at some depths. Pigmented (mixotrophic) flagellates were major grazers during winter and spring blooms, when they contributed up to 45% of community grazing on an areal basis and 79% at depths of maximum abundance. In late spring to early summer, rotifers and ciliates were responsible for as much as 25 and 30% of bacterivory at some depths, but averaged 3 and 11% over the year, respectively. Grazing impact of cladoceran crustaceans was generally < 1% of the total. Bacterivory by copepods was not detected. Total bacterial mortality due to grazing ranged from 11 to 162% of bacterial cell production estimated from the incorporation of [3H]thymidine. Use of 0.57-pm microspheres as tracers gave similar estimates ofingestion to fluorescently labeled bacteria in this system. The use of 4% ice-cold glutaraldehyde mixed 1 : 1 with the water sample was found to be equally effective to an acrolein-tannic acid mixture for reducing egestion of particles by protists. We therefore consider our findings to be representative of bacterivory by the planktonic community in this eutrophic system.

Medicine is experiencing an unprecedented focus on quantifying and improving health care quality. The American College of Cardiology (ACC) and the American Heart Association (AHA) have developed a multifaceted strategy to facilitate the process of improving clinical care. The initial phase of this